# Situation: A 64-year-old man who has smoked for 40 years and drinks alcohol daily is admitted for esophagectomy with gastric pull-up for squamous cell carcinoma of the esophagus. Which symptom pattern is MOST typical of the disease that brought him to surgery?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630370  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 64-year-old man who has smoked for 40 years and drinks alcohol daily is admitted for esophagectomy with gastric pull-up for squamous cell carcinoma of the esophagus.

Which symptom pattern is MOST typical of the disease that brought him to surgery?

## 보기

1. Dysphagia to solids first, later to liquids **✔ 정답**
2. Dysphagia to solids and liquids from the start
3. Heartburn that is relieved quickly by antacids
4. Painless vomiting of blood after retching

**정답: 1**

## 해설

Esophageal cancer narrows the lumen mechanically, so dysphagia is progressive — solids first, then liquids — with weight loss. Motility disorders such as achalasia cause dysphagia to solids and liquids from the start.

## 심화 해설

The typical symptom pattern
Esophageal cancer grows into the lumen and narrows it mechanically. The typical result is progressive dysphagia: difficulty swallowing solids first, then soft foods, and later liquids, usually with weight loss. Dysphagia that starts with solids and progresses to liquids points to a mechanical obstruction such as a tumor.

Why the progression occurs
Solid food needs the widest opening to pass, so it is the first to stick as the lumen narrows. As the tumor enlarges, softer foods and finally liquids are affected. By the time symptoms appear, the tumor is often advanced, because the esophagus can stretch considerably before swallowing is impaired. Weight loss results from reduced intake and the effects of cancer. This client has the two major risk factors for squamous cell carcinoma of the esophagus, smoking and heavy alcohol use; adenocarcinoma, by contrast, is linked to long-standing reflux and Barrett esophagus.

| Symptom pattern | Most likely cause |
| --- | --- |
| Dysphagia to solids first, later to liquids | Mechanical obstruction such as esophageal cancer |
| Dysphagia to solids and liquids from the start | Motility disorder such as achalasia |
| Heartburn relieved quickly by antacids | Gastroesophageal reflux disease |
| Painless vomiting of blood after retching | Mucosal tear at the gastroesophageal junction |

Why the other patterns fit other conditions
Watch out! The timing of dysphagia is the key clue. In motility disorders such as achalasia, the lower esophageal sphincter fails to relax and peristalsis is impaired, so solids and liquids are affected from the start. Heartburn that is promptly relieved by antacids suggests reflux, not a narrowing tumor. Vomiting blood after forceful retching suggests a mucosal tear at the gastroesophageal junction, often after heavy alcohol intake and vomiting, which is unrelated to a slowly growing cancer.

Nursing implications
Clients with esophageal cancer are often malnourished before surgery. The nurse assesses weight history and swallowing, works with the dietitian on high-calorie, high-protein soft or liquid diets, and watches for aspiration and regurgitation of undigested food. Preoperative nutritional support improves healing after esophagectomy. Smoking and alcohol cessation are also encouraged.

Exam takeaway
Key point! Esophageal cancer = progressive dysphagia, solids then liquids, with weight loss. Achalasia = solids and liquids from the onset. Smoking and alcohol are the key risk factors for squamous cell carcinoma of the esophagus.

## 임상 시나리오

Dysphagia in Esophageal CancerReading the pattern of swallowing difficulty
A tumor narrows the lumen, causing progressive dysphagia: solids first, then liquids, usually with weight loss.

Dysphagia to solids and liquids from the start suggests a motility disorder such as achalasia. Heartburn relieved by antacids suggests reflux.

Smoking and heavy alcohol use are the main risk factors for squamous cell carcinoma of the esophagus.

CautionThese clients are often malnourished before surgery. Assess weight and swallowing, plan nutritional support, and watch for aspiration of regurgitated food.

## 핵심 개념

- **Progressive dysphagia** — Swallowing difficulty that worsens over time, typically from solids to liquids.
- **Esophageal cancer** — A malignant tumor of the esophagus, commonly squamous cell carcinoma or adenocarcinoma.
- **Achalasia** — A motility disorder in which the lower esophageal sphincter fails to relax normally.
- **Squamous cell carcinoma** — A cancer of the esophageal lining strongly linked to smoking and alcohol use.
- **Esophagectomy** — Surgical removal of all or part of the esophagus, often with stomach pull-up.

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